Redefining Safe Practices in Airway TruBlue Laser Surgery-A Systematic Evaluation.

Objectives: Fire risk during laser airway surgery is well-documented, but there is limited information regarding this risk with the novel TruBlue laser. This study evaluates its safety under different experimental conditions.

Methods: Using a cadaveric porcine larynx and lungs model, we conducted trials with laser-safe endotracheal tubes (LSETTs), high-flow ventilation (HFV), and jet ventilation. We varied distance, FiO levels, and laser power settings to observe the occurrence of uncontrolled fires, brief flames, and sparks.

Results: LSETT trials showed no fire events. Pledget fires were the only uncontrolled fires in HFV, at 100%, 70%, and 50% FiO. Brief flames occurred only with 4 W continuous settings at 100% FiO. Innocuous spark ignition rates were significantly increased by increased wattage (p < 0.05). In jet ventilation trials, brief flames appeared across a wider range of FiO levels and settings. HFV and jet ventilation groups showed a greater frequency and earlier occurrence of sparks and brief flames, in contrast to the event-free LSETT group (p < 0.05).

Conclusion: Using the TruBlue laser with a fully inflated LSETT cuff positioned at least 0.3 cm below the operating area while delivering 100% oxygen was consistently safe in our trials. Uncontrolled fires occurred only when targeting a pledget under HFV, confirming extrinsic fuel as the main risk and highlighting the safety of the TruBlue laser with HFV and jet ventilation in its absence. Compared to HFV, jet ventilation trials showed a higher frequency of brief flames and sparks. A 60-s continuous application of the laser at 100% FiO is safe.

Level Of Evidence: NA.